Because the NIS reports hospital discharges rather than unique patients, we were unable to identify patients with multiple hospitalizations or estimate the per-person costs of hepatitis A inpatient care. We were also not able to separately report the costs associated with liver transplantation. Even though using highly sensitive inclusion criteria might have introduced an element of cost over-estimation in some patients incidentally diagnosed with hepatitis A while admitted for other conditions, our results almost certainly underestimate hospitalization costs associated with the ongoing hepatitis A outbreaks because NIS does not include hospital-based physician fees. Moreover, the national $306.8 million estimate does not account for outpatient visits , emergency department visits that did not result in an admission to the same hospital, lost productivity , out-of-pocket costs to patients or their informal caregivers, or public health costs associated with the hepatitis A outbreaks, further reinforcing the conservative nature of this estimate. Given the high proportion of hospitalized patients during the ongoing hepatitis A outbreaks, we estimated the average hepatitis A-related hospitalization costs to highlight the preventable economic burden of these outbreaks on healthcare systems and state governments. Hepatitis A is a vaccine-preventable disease. Despite longstanding vaccination recommendations for adults at increased risk for hepatitis A virus infection or adverse consequences of infection, self-reported adult hepatitis A vaccination coverage with >2 doses was only 10.9% for persons >19 years of age in 2017 (6). Our findings underscore the importance of improving hepatitis A vaccination coverage among at-risk adults, in accordance with Advisory Committee on Immunization Practices recommendations (7).
Because the NIS reports hospital discharges rather than unique patients, we were unable to identify patients with multiple hospitalizations or estimate the per-person costs of hepatitis A inpatient care. We were also not able to separately report the costs associated with liver transplantation. Even though using highly sensitive inclusion criteria might have introduced an element of cost over-estimation in some patients incidentally diagnosed with hepatitis A while admitted for other conditions, our results almost certainly underestimate hospitalization costs associated with the ongoing hepatitis A outbreaks because NIS does not include hospital-based physician fees. Moreover, the national $306.8 million estimate does not account for outpatient visits , emergency department visits that did not result in an admission to the same hospital, lost productivity , out-of-pocket costs to patients or their informal caregivers, or public health costs associated with the hepatitis A outbreaks, further reinforcing the conservative nature of this estimate. Given the high proportion of hospitalized patients during the ongoing hepatitis A outbreaks, we estimated the average hepatitis A-related hospitalization costs to highlight the preventable economic burden of these outbreaks on healthcare systems and state governments. Hepatitis A is a vaccine-preventable disease. Despite longstanding vaccination recommendations for adults at increased risk for hepatitis A virus infection or adverse consequences of infection, self-reported adult hepatitis A vaccination coverage with >2 doses was only 10.9% for persons >19 years of age in 2017 (6). Our findings underscore the importance of improving hepatitis A vaccination coverage among at-risk adults, in accordance with Advisory Committee on Immunization Practices recommendations (7).
Because the NIS reports hospital discharges rather than unique patients, we were unable to identify patients with multiple hospitalizations or estimate the per-person costs of hepatitis A inpatient care. We were also not able to separately report the costs associated with liver transplantation. Even though using highly sensitive inclusion criteria might have introduced an element of cost over-estimation in some patients incidentally diagnosed with hepatitis A while admitted for other conditions, our results almost certainly underestimate hospitalization costs associated with the ongoing hepatitis A outbreaks because NIS does not include hospital-based physician fees. Moreover, the national $306.8 million estimate does not account for outpatient visits , emergency department visits that did not result in an admission to the same hospital, lost productivity , out-of-pocket costs to patients or their informal caregivers, or public health costs associated with the hepatitis A outbreaks, further reinforcing the conservative nature of this estimate. Given the high proportion of hospitalized patients during the ongoing hepatitis A outbreaks, we estimated the average hepatitis A-related hospitalization costs to highlight the preventable economic burden of these outbreaks on healthcare systems and state governments. Hepatitis A is a vaccine-preventable disease. Despite longstanding vaccination recommendations for adults at increased risk for hepatitis A virus infection or adverse consequences of infection, self-reported adult hepatitis A vaccination coverage with >2 doses was only 10.9% for persons >19 years of age in 2017 (6). Our findings underscore the importance of improving hepatitis A vaccination coverage among at-risk adults, in accordance with Advisory Committee on Immunization Practices recommendations (7).
Dengue disease has been known to the people of Indonesia since 1779. The Aedes mosquito has two types, namely Aedes aegypti and Aedes albopictus. Aedes aegypti is a mosquito that carries the dengue virus. The dengue fever cases in Bali province tend to increase from year to year, especially when approaching the rainy season. The government's preventive action is needed to tackle the spread of the dengue virus and casualties. Data mining attempts to extract known knowledge or use historical data to find regularity patterns and relationships in a set of data. In this study, data mining predicts the number of dengue cases in Bali's province. The prediction uses several database variables to predict future variables' values, which are not currently known. The process of estimating predictive values based on patterns in a data set. This forecasting aims to assist the government in predicting dengue fever cases in the coming period to prepare appropriate prevention efforts. Forecasting dengue fever cases are carried out using three methods: backpropagation, gaussians, and support-vector machine. The amount of data used was 528 sample data, from 2008 to 2018. The results obtained are that the backpropagation method is better at predicting dengue fever cases with a MAPE error rate of 0.025. Simultaneously, the gaussian method has a MAPE error rate of 0.035, and support-vector machine has a MAPE error rate of 0.060. ; Dengue disease has been known to the people of Indonesia since 1779. The Aedes mosquito has two types, namely Aedes aegypti and Aedes albopictus. Aedes aegypti is a mosquito that carries the dengue virus. The dengue fever cases in Bali province tend to increase from year to year, especially when approaching the rainy season. The government's preventive action is needed to tackle the spread of the dengue virus and casualties. Data mining attempts to extract known knowledge or use historical data to find regularity patterns and relationships in a set of data. In this study, data mining predicts the number of dengue cases in Bali's province. The prediction uses several database variables to predict future variables' values, which are not currently known. The process of estimating predictive values based on patterns in a data set. This forecasting aims to assist the government in predicting dengue fever cases in the coming period to prepare appropriate prevention efforts. Forecasting dengue fever cases are carried out using three methods: backpropagation, gaussians, and support-vector machine. The amount of data used was 528 sample data, from 2008 to 2018. The results obtained are that the backpropagation method is better at predicting dengue fever cases with a MAPE error rate of 0.025. Simultaneously, the gaussian method has a MAPE error rate of 0.035, and support-vector machine has a MAPE error rate of 0.060.
Background: Ebola Hemorrhagic Fever (EHF) has become well known all over the world, especially following the West African outbreak in Guinea, Sierra Leone and Liberia (December 2013). The Ebola virus was first discovered in the Democratic Republic of Congo (DRC), an African country that has continued to register Ebola outbreaks. This study aims to summarize old and new experiences of Ebola in the DRC, in order to propose strategies for better prevention. Materials and Methods: Information was taken from databases such as PubMed and Cochrane library. A total of eleven full text and three abstracts were identified for the data extraction. Results: Since its discovery in the DRC, there have been seven Ebola outbreaks, accounting for a total of 1032 cases and 795 deaths. The presence of Non-Human Primates, also considered as the natural reservoir and susceptible host of Ebola virus, can be one major factor that has contributed to the increased number of Ebola outbreaks and cases in the Equatorial region. The existence of rumors and legends related to Ebola in DRC obscure the the viral nature of the disease, and lead to difficulty for health workers, to easily accomplish their tasks. Conclusion :It is important ,to scale up community education campaigns designed to give more details on the viral nature of the EHF, establish national agencies and institutions specialized in controlling hunting in the Equatorial region, for better prevention, since there is not yet a specific drug or vaccine to the Ebola Virus.
Crimean-Congo hemorrhagic fever virus (CCHFV) has been detected in many African countries. Unfortunately, little is known about the current CCHFV situation in most of those countries including the Democratic Republic of the Congo (DRC). In over 50 years, three human CCHF cases have been detected in DRC but no seroepidemiological investigation was performed so far. To determine the prevalence of CCHFV-specific antibodies we tested 838 serum samples of cattle, goat and sheep from the southern province Katanga, DRC. The detected seroprevalence in ruminants was 1.6% ranging from 0.4% to 3.4% between the two sampling sites, Kamina and Lubumbashi. The low prevalence indicates only sporadic introduction of CCHFV into this part of the country. DRC is a very large country and the study was performed only at two locations in one province; therefore, the investigations can be only a starting point for further epidemiological activities.
Abstract. Indonesia became the country with the highest number dengue cases in Asia, with as many as 80.065 cases, according to data by the United Nations in 2010. Dengue fever has killed hundreds, posing a threat to society against vector-based diseases, especially to those who are vulnerable to the impacts of climate change. The vulnerability of society will depend on their adaptive capacity in preventing or responding to an increased risk of disease transmission. In the efforts to increase resistance to the dengue risk, it will be difficult when only relying on increasing the quality of human resources in the health sector. In this context, the overall participation of the communities who are vulnerable of dengue becomes significant. DHF prevention programs with an alternative approach based on community participation in the ACTIVE (Actions Changing The Incidence of Vector- Borne Endemic Diseases) program in Semarang have been carried out by Mercy Corps Indonesia (MCI) with the Government of Semarang (Health Department, Development Planning Agency, Meteorology Climatology and Geophysics Agency, Department of Education) as well as academics of Diponegoro University. A series of activities in the ACTIVE program aims to build a city resilient to climate change, especially in the health sector by reducing the incidence of dengue. This paper aims to assess an alternative approach based on participation implemented through the concept of community capacity building within the framework of ACTIVE Program. The method used is descriptive analysis with a qualitative approach to the process of community capacity building. An alternative approach based on the concept of social learning and inclusive planning is able to get the government's attention and arouse the enthusiasm and the spirit of the community facing dengue in the region. Based on interviews with stakeholders, they generally refer to the alternative approach based on participation as interesting and consider the approaches effective in solving the problems ...
This exciting new work on vascular neurology offers a richly illustrated and practical guide to assist in the clinical management and decision-making involved in this complex field. The authors have assembled a comprehensive collection of original visual material to create a uniquely informative visual reference for specialists and trainees alike.
บทคัดย่อ การวิจัยเชิงปฏิบัติการ (Action Research) นี้ มีวัตถุประสงค์เพื่อศึกษาโปรแกรมการป้องกันและควบคุมโรคไข้เลือดออกในชุมชน โดยกระบวนการเรียนรู้แบบมีส่วนร่วม พื้นที่ดำเนินการวิจัย เป็นตำบลที่มีอัตราป่วยด้วยไข้เลือดออกเป็นอันดับหนึ่งในอำเภอบ้านโป่ง จังหวัดราชบุรี ผู้เข้าร่วมการวิจัย ประกอบด้วย สมาชิกองค์การบริหารส่วนตำบล ครูอนามัยโรงเรียน อาสาสมัครสาธารณสุขประจำหมู่บ้าน เจ้าหน้าที่สาธารณสุข และตัวแทนครัวเรือน จำนวน 100 คน วิธีดำเนินการวิจัย ใช้กระบวนการเรียนรู้แบบมีส่วนร่วม ซึ่งประกอบด้วย 7 ขั้นตอน 1) การศึกษาชุมชนและการระบุผู้มีส่วนได้ส่วนเสีย 2) การกำหนดวิสัยทัศน์เกี่ยวกับการป้องกันและควบคุมโรคไข้เลือดออก 3) การระบุความจำเป็นในการป้องกันและควบคุมโรคไข้เลือดออก 4) การวิเคราะห์สาเหตุของการเจ็บป่วยด้วยโรคไข้เลือดออกในครัวเรือนและชุมชน 5) การวางแผนการป้องกันและควบคุมโรคไข้เลือดออกระดับครัวเรือนและชุมชน 6) การดำเนินงานตามแผนงาน 7) การติดตามและประเมินผลก่อนดำเนินการและหลังดำเนินการ 60 วัน เก็บรวบรวมข้อมูลโดยการสัมภาษณ์ สำรวจ และสังเกต เครื่องมือที่ใช้ในการวิจัย คือ แบบสัมภาษณ์ แบบสำรวจความชุกชุมของลูกน้ำยุงลายและยุงลายตัวเต็มวัย แบบสังเกตสิ่งแวดล้อม วิเคราะห์ข้อมูลโดยการแจกแจงความถี่ ร้อยละ ค่าเฉลี่ย และ Paired t-test ผลการวิจัย พบว่า หลังดำเนินการผู้เข้าร่วมการวิจัยมีความรู้ อยู่ในระดับสูง และปฏิบัติตนในการป้องกันและควบคุมไข้เลือดออก สูงกว่าก่อนดำเนินการ อย่างมีนัยสำคัญทางสถิติ (p<0.001) ค่า Breteau index, Container index, Landing rate และ Biting rate หลังการดำเนินงานต่ำกว่าก่อนการดำเนินงานอย่างมีนัยสำคัญทางสถิติ (p<0.01) นอกจากนี้พบว่า หลังดำเนินการผู้เข้าร่วมการวิจัยมีการปรับปรุงสิ่งแวดล้อมบริเวณโดยรอบครัวเรือนและชุมชนดีขึ้นเมื่อเปรียบเทียบก่อนการดำเนินงาน แสดงให้เห็นว่า การดำเนินงานป้องกันและควบคุมโรคไข้เลือดออกโดยกระบวนการเรียนรู้แบบมีส่วนร่วมนั้น เป็นทางเลือกหนึ่งที่มีความเป็นไปได้ในทางปฏิบัติ เพื่อป้องกันและควบคุมโรคที่ต่อเนื่อง ยั่งยืน และเหมาะสมกับบริบทชุมชนอย่างแท้จริง Effectiveness of the Dengue Hemorrhagic Fever Prevention and Control Program in Community using a Participatory Learning ProcessNongnuch Suapumee*, Kuleudee Chittayanunt* Wandee Wongrattanarak* , Wantanee Naksrisang*Abstract This Action Research aimed to examine the effectiveness of the dengue hemorrhagic fever prevention and control program in community using a participatory learning process. The study site was a sub-district that had the highest incidence of dengue hemorrhagic fever in Banpong, Ratchaburi province. The participants were 100 stakeholders, including members of local government, school nurses, district health volunteers, health personnel, and householders. The participatory learning process including 7 steps was employed as follows; 1) exploring the community and identifying stakeholders, 2) setting a vision of dengue hemorrhagic fever prevention and control, 3) identifying the needs of dengue hemorrhagic fever prevention and control, 4) analyzing the causes of dengue hemorrhagic fever in households and communities, 5) planning for dengue hemorrhagic fever prevention and control, 6) implementing as planned, and 7) monitoring and evaluating 60 days after implementation. Data were collected through interview, survey, and observation. The instrument used was composed of a knowledge questionnaire about dengue hemorrhagic fever prevention and control, a survey of mosquito larvae, and an environmental observation form. Data were analyzed using frequency, percentage, mean, standard deviation, and Paired t-test. The results found that after implementing the dengue hemorrhagic fever prevention and control program in community, the participants reported a higher level of knowledge, a better behavior in dengue hemorrhagic fever prevention and control than those before the implementation. Breteau index, Container index, Landing rate, and Biting rate after implementing the program were significantly lower than before the implementation. In addition, the participants improved the environment surrounding their houses and community after participating in the program. The study suggests that the dengue hemorrhagic fever prevention and control program in community using a participatory learning process is effective and appropriate in the Thai community context.*Nurse instructor, Boromarajonani College of Nursing, Chakriraj
International audience ; Background : The 2018–2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data.Methods : We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level.Findings : The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05–0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones ( p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019.Conclusion : We characterized the association between variables documenting broad conflict ...
International audience ; Background : The 2018–2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data.Methods : We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level.Findings : The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05–0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones ( p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019.Conclusion : We characterized the association between variables documenting broad conflict levels and EVD transmission. Such assessment is important to understand if and how such conflict variables could be used to inform the outbreak response. We found that while these variables can help characterize long-term challenges and susceptibilities of the different regions they provide little insight on the short-term dynamics of EVD transmission.
Arenaviruses are rodent-borne emerging human pathogens. Diseases caused by these viruses, e.g., Lassa fever (LF) in West Africa and South American hemorrhagic fevers (HFs), are serious public health problems in endemic areas. We have employed replication-competent and replication-deficient strategies to design vaccine candidates potentially targeting different groups "at risk". Our leader LF vaccine candidate, the live reassortant vaccine ML29, is safe and efficacious in all tested animal models including non-human primates. In this study we showed that treatment of fatally infected animals with ML29 two days after Lassa virus (LASV) challenge protected 80% of the treated animals. In endemic areas, where most of the target population is poor and many live far from health care facilities, a single-dose vaccination with ML29 would be ideal solution. Once there is an outbreak, a fast-acting vaccine or post-exposure prophylaxis would be best. The 2nd vaccine technology is based on Yellow Fever (YF) 17D vaccine. We designed YF17D-based recombinant viruses expressing LASV glycoproteins (GP) and showed protective efficacy of these recombinants. In the current study we developed a novel technology to clone LASV nucleocapsid within YF17D C gene. Low immunogenicity and stability of foreign inserts must be addressed to design successful LASV/YFV bivalent vaccines to control LF and YF in overlapping endemic areas of West Africa. The 3rd platform is based on the new generation of alphavirus replicon virus-like-particle vectors (VLPV). Using this technology we designed VLPV expressing LASV GP with enhanced immunogenicity and bivalent VLPV expressing cross-reactive GP of Junin virus (JUNV) and Machupo virus (MACV), causative agents of Argentinian and Bolivian HF, respectively. A prime-boost regimen required for VLPV immunization might be practical for medical providers, military, lab personnel, and visitors in endemic areas.
